Carpal Tunnel Syndrome

More than just a wrist problem

Carpal tunnel syndrome is compression of the median nerve as it passes through the carpal tunnel, a narrow channel in the wrist formed by the carpal bones and the transverse carpal ligament. It's the most common peripheral nerve entrapment in the body, and it causes numbness, tingling, and pain in the thumb, index finger, middle finger, and the thumb side of the ring finger.

But here's something most people don't realize: the median nerve doesn't just exist at the wrist. It originates from nerve roots in the neck, passes through the thoracic outlet, travels down the arm under muscles and through fascial planes, and then enters the carpal tunnel. It can be compressed or irritated at any point along that path. This is why treating only the wrist sometimes doesn't resolve symptoms, and why a thorough evaluation matters.

What it feels like

The classic pattern is numbness and tingling in the first three and a half fingers: thumb, index, middle, and the thumb side of the ring finger. Many patients notice it at night or first thing in the morning, and they shake their hand to get the feeling back. As it progresses, the numbness can become constant, grip strength decreases, and you may start dropping things. In advanced cases, the muscles at the base of the thumb visibly shrink.

Not all hand tingling is carpal tunnel. Cervical radiculopathy, thoracic outlet syndrome, and ulnar neuropathy can all produce numbness in the hand with different patterns. Getting the diagnosis right matters because the treatment is different for each one.

How we diagnose it

The physical exam is where we start. Nerve conduction studies, EMG, and diagnostic ultrasound are how we can confirm the diagnosis and grade severity.

Nerve conduction studies measure how fast electrical signals travel through the median nerve across the wrist. If the nerve is compressed, conduction slows down. EMG evaluates the muscles supplied by the median nerve to determine if there's been any nerve damage, and it rules out common look-alike conditions that are not carpal tunnel. Ultrasound lets us visualise the nerve's physical structure. Together, these tests tell us three things: is it really carpal tunnel, how severe is it, and is the nerve just irritated or is it actually damaged? That information drives the treatment plan.

How we treat it

Mild to moderate carpal tunnel often responds well to conservative management. OMM can address restrictions in the cervical spine, thoracic outlet, forearm, and wrist that are contributing to nerve compression. Restoring normal mechanics through the whole path of the nerve, a concept called "nerve gliding," can make a meaningful difference.

Ultrasound-guided corticosteroid injections into the carpal tunnel can reduce inflammation and swelling around the nerve. Under ultrasound guidance, we can see the nerve in real time and deliver the medication precisely around it without injecting into the nerve itself.

Night splints hold the wrist in a neutral position during sleep. Most people flex their wrists while sleeping, which narrows the carpal tunnel and compresses the nerve for hours. A simple splint can significantly reduce nighttime symptoms.

Severe carpal tunnel documented by nerve conduction studies showing significant slowing or evidence of muscle wasting on EMG may benefit from threaded release right here in the office. Carpal tunnel release is one of the most successful surgeries, and when it's indicated, it works well.

When to seek care

Don't wait until you're dropping things. If you have persistent numbness in your fingers, if your hand falls asleep regularly at night, or if you've noticed weakness in your grip, come in for evaluation. Early carpal tunnel is very treatable. Advanced carpal tunnel with nerve damage may not fully recover even after release.

What you can do right now

If your symptoms are worse at night, try wearing a wrist splint to bed. You can get a basic one at any pharmacy. Look for a neutral-position splint that keeps the wrist straight, not a cock-up splint that extends it.

Take breaks from repetitive hand activity. If you type all day, pause every 30 minutes and gently extend and flex the wrist. Nerve gliding exercises, gently extending the fingers and wrist while the arm is straight, can help keep the nerve mobile.

Pay attention to your posture. A forward head position tightens the scalenes and pectoralis minor, which can compress the nerve at the thoracic outlet before it ever reaches the wrist. The nerve only has so much tolerance for compression along its entire path.